DEMENTIA RISK PREVENTION THROUGH LIFESTYLE RISK FACTORS
CAN-THUMBS UP: The Canadian Therapeutic Platform Trial for Multidomain Interventions to Prevent Dementia
Prior studies have shown that programs that focus on promoting brain health and managing lifestyle risks (such as poor diet, obesity, physical inactivity, sleep issues, loneliness) may help in preventing or lowering the risk of dementia. To address this, the CAN-THUMBS UP platform was developed to conduct studies that target lifestyle risk and focus on dementia prevention.
APPROACHES TO DEMENTIA PREVENTION
Brain Health PRO (BHPro) is an innovative online program designed to help reduce the risk of dementia by providing individuals with the tools and knowledge needed to make positive lifestyle changes. The program offers a flexible, user-friendly interface that allows users to assess their risk and engage with educational modules specifically tailored to their needs. BHPro covers a broad range of topics, from physical exercise to mental stimulation and chronic disease management.
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Brain Health PRO has been trialed in two studies so far and is being further tested and adapted for a number of other studies and initiatives. Please see studies section below for more information: Studies
The SYNERGIC approach is designed to evaluate the effect of aerobic and progressive resistance training exercises, isolated or combined with cognitive training and vitamin D supplementation, in older adults with Mild Cognitive Impairment (MCI).
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The SYNERGIC study started in 2016 and future adaptations were incorporated into the CTU platform when it was established in 2019. The SYNERGIC @ HOME study has been completed and the SYNERGIC 2 study, which compares the SYNERGIC approach to that of Brain Health PRO is underway.
For more information: Studies
CAN-THUMBS UP (CTU) is a group of 100 Canadian researchers within the Canadian Consortium on Neurodegeneration in Aging (CCNA) focused on addressing dementia prevention.
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CCNA itself was established in 2014. The CTU platform was initiated during the 2nd phase of CCNA in 2019 and is part of the World Wide FINGERS (WW-FINGERS) prevention initiative*. CTU has received funding to carry on from 2024 to 2029 with an exciting range of studies and initiatives planned.
*WW-FINGERS is a global network working to reduce the risk of cognitive decline and dementia through joint initiatives, shared experience, and harmonized data. ​​​​
SYNERGIC AT HOME
A total of 60 participants between the ages of 60 and 90 in New Brunswick were enrolled in this 16-week interventional study providing at-home physical exercise guidance and cognitive training delivered online. ​​
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Brain Health Support Program Pilot Study
Brain Health Support Program Main Study
A 12-month study with 350 participants aged 60-85 across Canada to determine whether Brain Health PRO has the ability to change dementia literacy, self-efficacy, attitudes toward dementia, modifiable risk factors, cognition, physical activity, and sleep quality.
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Participants in Quebec also had the option to join an implementation sub-study to assess the barriers and facilitators of implementing BHPro within community organizations.
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SYNERGIC 2
This study is a standard-tailored, single blinded, randomized controlled trial (RCT), testing a 12-month home-based personalized multidomain intervention to improve cognition in 550 older adults with mild cognitive impairment (MCI) and at least two additional dementia risk factors, compared with an online educational Brain Health Support Program (BHSP) intervention, called Brain Health PRO (BHPro, control arm). Both the multi-domain intervention and Brain Health PRO will be delivered remotely.
Indigenous Adaptation of BHPro
In Phase II, in collaboration with the CCNA Indigenous Cognitive Health Program (ICHP), we consulted with First Nations Communities to better understand the potential for implementing an Indigenous-focused BHPro. This pilot study will be executed by the ICHP and optimized for an Indigenous audience, with implementation and uptake involving local liaisons and community education and support. We will deliver a BHPro tailored to Indigenous Health yielding broader clinical implementation in Canada and suitable for testing in this population.
Risk Factor Reduction Study
Based on results of the BHSP studies, BHPro will be updated from its original form to improve user experience, enhance motivational elements, including visual feedback on daily and weekly goals, and non-monetary rewards. Participants will be recruited from across Canada for this fully remote study. Participants will be randomized to a 6-month BHPro intervention or a control group that completes lifestyle surveys only, followed by access to unsupervised BHPro after 6 months. We will survey the groups at 1 and 3 years to determine the lasting effects of BHPro on dementia risk, primarily on lifestyle improvements in identified risk factor domains.
Implementation Study
The Implementation of the Brain Health PRO project aims to develop and test the adoption and sustainability of the Brain Health PRO program in real-life settings, especially in rural and underserved communities. While initial studies demonstrated its efficacy in increasing dementia literacy and reducing risk factors, successful adoption in diverse community and clinical settings requires further assessment. We are now carrying out an implementation study to examine real-life contexts. The study follows a two-phase multi-site implementation approach: Phase 1 involves co-developing strategies with partners by identifying barriers and facilitators across public health agencies, community organizations, and clinical settings, while Phase 2 tests the adoption, sustainability, and real-world effectiveness of Brain Health PRO on older adults, service providers, and organizations. By contextualizing these strategies, the study aims to inform best practices for scaling up Brain Health PRO to enhance dementia prevention efforts, particularly among populations with limited access to healthcare resources.
Kimel Centre Study
Members of the Kimel Family Centre in Toronto will have the option to enrol in a research study to have access to BHPro in addition to face-to-face prevention programs of exercise, diet, cognitive engagement and social engagement along with active coaching and support from a counsellor. This study will provide important data on the added benefit of more intense programming support to BHPro education.
Sleep Study
Sleep apnea is associated with poorer sleep and may also contribute to dementia such as Alzheimer’s disease (AD). However, it remains unclear if sleep apnea is a risk factor for dementia or a concomitant disorder in people who are at a higher risk for dementia.
This study aims to investigate if a causal relationship exists between sleep apnea and dementia by conducting an interventional study (randomized control trial) to compare the dementia risk profile of people with sleep apnea treated with CPAP (continuous positive airway pressure) versus those who are not treated with CPAP. The study will assess if CPAP therapy can improve cognitive performance and reduce pathological markers associated with AD. If successful, this project will show that sleep apnea could be a risk factor for dementia, and that treatment of sleep apnea with CPAP may contribute to reducing the risk for AD. As an alternative to CPAP, control participants in this study will have access to educational materials from the sleep topic of Brain Health PRO.
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